Boulder City Bears Tackle Football Registration Fall 2025
Date Today
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*payment must be received within 5 days from completion of this form. Payment plans and scholarships are available.
Player Name
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First Name
Last Name
Date of Birth
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Age
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Team Application Information
Please select grade level for 2025-2026 CCSD school year
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Please Select
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
*your team assignment will be based on your Grade as well as weight
Player’s Weight
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Years of tackle football experience
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Please Select
None
1 Season
2 Seasons
3 Seasons
4 Seasons
5+ Seasons
Returning Bears player?
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Please Select
Yes
Yes, but only flag football
No
Parent Contact Information
Full Name
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First Name
Last Name
Phone Number
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Format: (000) 000-0000.
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Relation to Athlete
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Email Address
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Parental/Guardian Consent
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I, the undersigned parent/guardian, grant permission for my child to participate in Boulder City Bears Youth Tackle Football Program during the 2025-2026 season. I understand that tackle football is a physical and potentially hazardous activity, and I acknowledge the inherent risks associated with this sport, including but not limited to sprains, strains, fractures, concussions, and other serious injuries.I confirm that my child is in good physical condition and has no known medical conditions that would prevent participation. I agree to provide all required medical clearance forms and information as requested by the program.
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WAIVER - I am fully aware that this sport activity may cause accidental injury to athletes. I likewise assume any and all possible risk that may cause injury, illness, or death arising to such activity. I hereby declare that I waive my right to pursue any and all claims against the Commission and the Organizing Committee of this event should in any case that the accident, injury, illness or death occurs in the course of any activity held by them.
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I acknowledge that the registration (1) payment of $175; or (2) payment plan agreement; must be received within 5 days of completion of this form or my child will be removed from the active roster.
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I acknowledge that all registration fees are non-refundable.
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I allow my child’s image to be used to promote the BC Bears
Choose method of payment
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Please Select
Cash
Check (made out to BC Bears)
Zelle (to 702-250-9029)
Payment Plan - (must be paid in full by 6/1/25)
I applied for a scholarship
Instructions for payment options will be emailed upon completion of this form.
I or my significant other is interested in coaching tackle football for the 2025 season. (You will be required to complete a certification through USA Football and pass a background check)
I or my significant other are interested in being on the fundraising committee. (Required for Scholarship applicants)
I or my significant other are interested in being on the end of the season banquet committee (Required for Scholarship applicants)
I or my significant other are interested in being on the Christmas Parade committee (Required for Scholarship applicants)
Name
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First Name
Last Name
Date Signed
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Date
Submit
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